A 68-year-old woman presents 2 hours after sudden right-sided weakness and aphasia. NIHSS is 14. Non-contrast CT shows no hemorrhage, ASPECTS 9. BP is 168/92, glucose 140 mg/dL, INR 1.0. Per the 2026 AHA/ASA acute ischemic stroke guideline, which of these IV thrombolytic regimens is recommended?
Principles Of Neurocritical Care
Question · Medium
What does a focused neuro-ICU exam add beyond the Glasgow Coma Scale (GCS)?
Neuro Exam & Cerebral Physiology
Flashcard
A patient receives IV alteplase for acute ischemic stroke. What is the recommended blood pressure target during and for 24 hours after thrombolysis?
Neurocritical Care Diseases
Question · Easy
Monitored reading above 22 mmHg after severe head trauma that calls for treatment; levels above it are tied to higher mortality.
Neuro-ICU physiology
Guess the Term
Introduction & Exam Overview
1.1 Current Exam Facts
Study guide
Cheat sheet
A 72-year-old presents 8 hours after last known well with NIHSS 18 from a left M1 occlusion. CT perfusion shows an ischemic core of 18 mL and a total hypoperfused (Tmax >6 s) volume of 90 mL. Per DAWN and DEFUSE 3, what is the most appropriate next step?
Read the clue and guess the term in 6 tries.
Game
How does the Monro-Kellie doctrine explain the limits of intracranial compensation?
Per the 2026 AHA/ASA acute ischemic stroke guideline, a patient with an ICA or M1 occlusion presenting within 6 hours (prestroke mRS 0-1, ASPECTS 3-10) has a Class 1 recommendation for thrombectomy when the NIHSS score is at least:
Value calculated by subtracting the intracranial reading from the mean arterial reading, targeted at 60 to 70 mmHg after severe head trauma.
Per the 2026 AHA/ASA guideline, an 84-year-old with an M1 occlusion presents 10 hours after last known well (NIHSS 16, prestroke mRS 0, no significant mass effect). Thrombectomy carries a Class 1 recommendation if the ASPECTS is:
Why does impaired cerebral autoregulation matter after TBI, SAH, or stroke?
The HERMES individual-patient meta-analysis of five early thrombectomy trials reported approximately what number needed to treat to reduce disability by at least one modified Rankin Scale level at 90 days?
Clear liquid that cushions the nervous system, is made daily, and returns to the bloodstream; blocked flow widens the ventricles.
1.2 Eligibility, Practice Pathway, and the IM Training Route
A 60-year-old man presents 3 hours after onset of an acute ischemic stroke with NIHSS 9. He took apixaban 5 mg 4 hours ago, and no drug-specific anti-Xa assay is available. Which is the most appropriate decision regarding IV thrombolysis?
Question · Hard
Swap tiles to line up three of the same term.
Term Match
How does mannitol lower ICP, and what should be monitored during its use?
Neuropharmacology
Which imaging modality is the most sensitive for detecting hyperacute (within 30 minutes) cerebral ischemia?
Diagnostic Studies And Procedural Skills
Swelling of brain tissue after injury; rising pressure inside the skull can displace tissue and cause herniation, disability, or death.
A 64-year-old undergoes successful mechanical thrombectomy for left M1 occlusion. NIHSS improved from 18 to 6. Six hours post-procedure, NIHSS is 22 and head CT shows new parenchymal hematoma. The most likely diagnosis is:
Why might hypertonic saline be preferred over mannitol in a hemodynamically unstable neuro-ICU patient?
A 75-year-old woman presents 12 hours after last known well with right hemiparesis and aphasia from left M1 occlusion. NIHSS 22, ASPECTS 8. CT perfusion shows core 25 mL, penumbra 110 mL. Per DAWN, which clinical-core mismatch criterion supports thrombectomy?
Hypertonic ___: an osmotic agent used alongside mannitol in North America; it may be hazardous when the patient is already low on sodium.
Neuro-ICU pharmacology
1.3 Format, Scoring, Pearson VUE, and Score Reports
A 70-year-old on warfarin (INR 3.2) presents with sudden right hemiparesis and altered consciousness. CT shows a 40 mL left basal ganglia hemorrhage. Which is the most appropriate immediate reversal strategy?
Flip two cards at a time to find matching terms.
Term Pairs
How is warfarin-associated intracranial hemorrhage reversed?
A patient with a mild-to-moderate spontaneous ICH presents with SBP 195 mmHg. Per the 2022 AHA/ASA ICH guideline, the recommended acute SBP management is:
Four-factor clotting product that urgently reverses warfarin-related deficiency in adults with major bleeding or before urgent surgery; give vitamin K with it.
A 67-year-old taking apixaban presents with a 25 mL right thalamic hemorrhage 6 hours after his last dose. Andexanet alfa (Andexxa) was withdrawn from the US market in December 2025. Per current US practice, which agent is preferred for hemostatic management of this factor Xa inhibitor-related ICH?
What agent reverses dabigatran, and how is it dosed?
A patient on dabigatran 150 mg twice daily presents with a large lobar ICH. The most appropriate specific reversal agent is:
Overactive whole-body reaction to an infection that can lead to tissue damage, organ failure and death without quick treatment.
Organ-system complications
1.4 How to Use This Independent Study Guide
A patient with a 4 cm cerebellar hemorrhage develops worsening obtundation and brainstem compression on imaging. The most appropriate intervention is:
Find five hidden terms in a grid of letters.
Term Search
How is apixaban- or rivaroxaban-associated ICH reversed in the US now that andexanet alfa is off the market?
A 52-year-old woman presents with the worst headache of her life. CT shows diffuse subarachnoid blood. CTA reveals a 7 mm anterior communicating artery aneurysm. Per ISAT, which definitive treatment is generally preferred when both options are anatomically feasible?
Condition in which not enough blood and oxygen reach the organs, causing very low blood pressure; it can be life-threatening and often follows serious injury.
Which medication should be initiated and continued for 21 days in all patients with aneurysmal subarachnoid hemorrhage?
Why is propofol often favored for sedation in the neuro-ICU, and what is its key risk?
A patient on day 7 after aneurysmal SAH develops new left arm weakness and confusion. Transcranial Doppler shows MCA mean velocity 220 cm/s with a Lindegaard ratio of 7. The most likely diagnosis is:
Disorder in which the body holds on to too much water, diluting blood sodium while the urine stays very concentrated; brain injury, infection or stroke can cause it.
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